Exploring factors influencing the consistent adoption of a post-stroke upper extremity outcome measure using...

Area of Science:

• Neurorehabilitation
• Clinical Implementation Science
• Occupational Therapy

Background:

• Stroke rehabilitation guidelines advocate for outcome measures like the Fugl-Meyer Assessment for Upper Extremity (FMA-UE).
• Integrating FMA-UE into routine clinical practice is challenging within evolving healthcare models.
• Understanding implementation barriers and facilitators is crucial for sustained use.

Purpose of the Study:

• To identify barriers and facilitators for the routine use of FMA-UE in hospital-based occupational therapists.
• To apply a theory-driven approach, specifically Normalisation Process Theory (NPT), to understand sustained implementation.

Main Methods:

• A mixed-method sequential exploratory design was employed.
• Quantitative data collected via a validated survey (n=34).
• Qualitative data gathered through focus group discussions analyzed with directed content analysis.

Main Results:

• Survey results indicated barriers related to NPT's collective action and coherence constructs.
• Facilitators were associated with NPT's cognitive participation construct.
• Key barriers included insufficient coaching, competing priorities, and perceived limited value; facilitators included role legitimation and open learning culture.

Conclusions:

• A theory-based approach successfully identified barriers and facilitators to sustained FMA-UE use.
• Findings provide insights for developing effective implementation strategies.
• The study supports embedding FMA-UE into routine practice for improved stroke rehabilitation outcomes.